By Jennifer Larson, contributor
January 15, 2013 - A new piece of proposed federal legislation could vastly expand the reach of telemedicine.
Introduced by U.S. Rep. Mike Thompson, D-CA, the Telehealth Promotion Act of 2012 (HR 6719) would increase federal support and payments for telehealth services.
Among other provisions, the act would enable telehealth providers to be reimbursed for telehealth visits or consultations at the same rate that in-person consultations are reimbursed, thereby increasing access to telemedicine for people covered by Medicare, Medicaid, TRICARE, Children’s Health Insurance Program (CHIP), Department of Veterans Affairs and federal employee health plans. It would also remove some coverage restrictions that currently hinder the provision of telemedicine across state lines.
According to the American Telemedicine Association, current state-by-state medical licensure and practice regulations are too restrictive, so the association has publicly endorsed the new bill. The association noted that Congress expanded an exemption from multiple state licenses for the
Departments of Defense and Veterans Affairs in 2011, and the association would like to see the exemption extended on a broader level to include others.
“This would be a huge benefit to many health care professionals out there,” said Gary Capistrant, senior director of public policy for the American Telemedicine Association.
Take Mercy, a Catholic health care system that provides care to patients in four states: Arkansas, Kansas, Missouri and Oklahoma. The health care system’s telehealth services program works to give people in the region greater access to care, including specialty care. To provide this care, the system employs approximately 70 nurses to work in the teleICU. There are also two physicians on duty on day shifts and three working night shifts; approximately 40-50 physicians who also work at the bedside contribute their time to filling these shifts.
To ensure those personnel can practice, Mercy employs two full-time credentialers who make sure everyone’s licensure and credentials are up-to-date in all the states, as well as making sure that the staff have the appropriate privileges with the various facilities. They also work to get them accepted by the various health insurance companies’ and managed care plans’ coverage. It’s time- and labor-intensive, said Wendy Deibert, RN, BSN, executive director of telemedicine services for Mercy.
“Since we cover four states, we deal with that on a daily basis,” she said.
In fact, Mercy will probably hire additional credentialers in the coming year to handle all the paperwork required to make the practice of telemedicine possible. Getting rid of barriers like coverage restrictions would be very helpful in streamlining the process and in allowing them to provide care, especially to patients in rural areas, Deibert said.
Capistrant noted that the law could result in cost savings, just from removing those restrictions. Approximately $300 million is spent each year on multi-state licensure for physicians, he said. Nurses have made more progress, with the multi-state Nurse Licensure Compact, but not every state participates in that agreement.
Many say that if the bill becomes law, it could open up new possibilities for nurses. The law heralds the move toward the coordinated care model, in which nurses often play a major role, Capistrant said.
“That would seem to be attractive for the advanced practice nurse and others who could operate more fully within the scope of their license,” he said.
Other provisions of the Telehealth Promotion Act of 2012 include a number of “improvements to Medicare,” including positive incentives for Medicare's hospital readmissions reduction program for hospitals using telemedicine, and the use of telehealth and remote patient monitoring services as part of an intervention proposal under the Medicare Community-Based Care Transitions Program. The bill would also create a telemedicine option to treat high-risk pregnancies in women participating in the Medicaid program.
“This is a way to use technology to be a real benefit to people,” said Capistrant,
Although the act was introduced at the very end of 2012, Thompson has said that he is planning to reintroduce the same bill in the new session of Congress, which just began. The ATA has already expressed its support for the provisions in the bill, but noted that lawmakers may have to deal with some opposition from state medical boards because the bill would allow clinicians to practice in states where they are not currently licensed.
To find the latest state licensure requirements, visit NurseZone’s Nurse Licensure page.
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